Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Department of Orthopaedics and Trauma Surgery, University Medical Center Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
Arch Orthop Trauma Surg. 2023 Mar;143(3):1663-1670. doi: 10.1007/s00402-022-04402-8. Epub 2022 Mar 28.
Prior to revision of total hip arthroplasty (THA), low-grade chronic periprosthetic joint infection (PJI) is often difficult to diagnose. We aimed to determine the diagnostic accuracy of open incisional tissue biopsy for the prediction of PJI prior to THA revision in cases with culture-negative or dry tap joint aspirates.
This retrospective single-center study includes 32 consecutive THA revision cases with high clinical suspicion of low-grade chronic PJI of the hip with culture-negative or dry tap joint aspirates and without systemic signs of infection. Open incisional biopsy (OIB) was performed prior to revision surgery. Periprosthetic tissue samples were analyzed by microbiology and histopathology for PJI. During definitive revision arthroplasty, identical diagnostics were repeated. Results from both procedures were compared and sensitivity, specificity, positive and negative predictive values of OIB for the final diagnosis were calculated.
Average age at revision was 69.3 ± 13.5 years. The sensitivity of the OIB procedure was 80% (microbiology), 69% (histology) and 82% for combined analyses (microbiology and histology). Specificity of OIB was 80% (microbiology), 94% (histology) and 60% for combined analyses.
Open tissue biopsy performed in cases with culture-negative or inconclusive synovial fluid aspirates prior to revision of THA has limited diagnostic accuracy for the prediction of PJI. The procedure does not reliably close the diagnostic gap in a substantial number of cases. In this difficult patient population, risk of an open procedure may outweigh benefits and alternative less invasive methods should be considered for the preoperative diagnosis of PJI.
在翻修全髋关节置换术 (THA) 之前，低度慢性假体周围关节感染 (PJI) 通常难以诊断。我们旨在确定在关节抽吸培养阴性或干燥的情况下，翻修 THA 前开放性切开组织活检对预测 PJI 的诊断准确性。
这项回顾性单中心研究包括 32 例连续的 THA 翻修病例，这些病例高度怀疑患有髋关节低度慢性 PJI，关节抽吸培养阴性或干燥，且无全身感染迹象。在翻修手术前进行开放性切开活检 (OIB)。对假体周围组织样本进行微生物学和组织病理学分析以确定 PJI。在确定性翻修关节成形术中，重复相同的诊断。比较两种方法的结果，并计算 OIB 对最终诊断的敏感性、特异性、阳性预测值和阴性预测值。
翻修时的平均年龄为 69.3±13.5 岁。OIB 程序的敏感性为 80%（微生物学）、69%（组织学）和联合分析的 82%（微生物学和组织学）。OIB 的特异性为 80%（微生物学）、94%（组织学）和联合分析的 60%。
在翻修 THA 之前，对于关节抽吸培养阴性或结果不确定的病例，进行开放性组织活检对预测 PJI 的诊断准确性有限。该程序并不能可靠地解决大量病例的诊断差距。在这种困难的患者人群中，开放性手术的风险可能超过获益，应考虑替代的微创方法来术前诊断 PJI。
